1. © Manipal International University 2014 1
Established by: MANIPAL EDUCATION MALAYSIA SDN. BHD. (912256-H)
SECTION B PERSONAL DETAILS
Applicant’s Particulars
Complete ALL information in ALL sections with BLOCK LETTERS (in BLACK or BLUE ink only) and signed.
Please state name as per your MyKad or Passport.
To avoid delays in your application, it is important that you provide ALL your details clearly including your email address.
Full Name
(as in MyKad or Passport)
MyKad No. OR Passport No. : Gender  Male  Female
Nationality: Race  Malay
 Chinese
 Indian
 Others (please specify)
_______________________________
Country of Birth:
Date of Birth (Day/Month/Year) :
Telephone No. (Please include international code): Religion  Islam  Christian
Mobile No. (Please include international code):  Hindu  Buddhist
Email Address:
(mandatory)
 Others (Please specify) ___________________________
Correspondence Address : Marital status (Accurate status is required to process International student visa):
 Single  Married  Others
City: Postcode:
State: Country:
Medical / Special Needs
The information below is used to assist the University in monitoring, supporting and improving service to students with medical disability requirements. Disclosing this information will not
affect your admission to the University.
Do you have a disability, impairment or long term medical condition which may affect your studies?  Yes  No
If yes, please indicate the type(s) of medical condition.
 Hearing  Vision  Learning  Medical mobility  Others (Please specify)
__________________________________________________
SECTION A PROGRAMME PREFERENCE
Please indicate your choice of programme by marking it in the box. 1 – Most Preferred and 5 – Least Preferred. You are allowed to make up to 5 choices.
CENTRE FOR FOUNDATION STUDIES CENTER FOR POSTGRADUATE STUDIES
□ Foundation in Business Studies □ Master of Business Administration (Full Time Mode)
□ Foundation in Engineering □ Master of Business Administration (Part Time Mode)
□ Foundation in Science
SCHOOL OF SCIENCE AND ENGINEERING SCHOOL OF MANAGEMENT & BUSINESS
□ Bachelor of Chemical Engineering (Hons) □ Diploma in Business Administration
□ Bachelor of Civil Engineering (Hons) □ Bachelor of Accounting (Hons)
□ Bachelor of Computer Engineering (Hons) □ Bachelor of Actuarial Finance (Hons)
□ Bachelor of Computer Science (Hons) □ Bachelor of Business Administration (Hons)
□ Bachelor of Electrical and Electronics Engineering (Hons) □ Bachelor of Business Administration (Hons) Finance
□ Bachelor of Electronics Engineering (Communication) (Hons) □ Bachelor of Business Administration (Hons) International Business
□ Bachelor of Mechanical Engineering (Hons) □ Bachelor of Business Administration (Hons) Islamic Finance
□ Bachelor of Science (Biotechnology)(Hons) □ Bachelor of Business Administration (Hons) Marketing
APPLICATION FOR ADMISSION
For office use only
Ref No.
Nationality
Malaysian  International 
Intake
February  April  June  September 
Affix your passport-sized
photo here

2. © Manipal International University 2014 2
SECTION C PARENT/GUARDIAN DETAILS
Parent/Guardian Particulars
Father’s/Guardian’s Name:
(as in MyKad or Passport)
Nationality of Father/Guardian: Gender  Male  Female
Home Address (if this differs from the correspondence address above) :
City: Postcode: State: Country:
Telephone No. (Please include international code): Mobile No. (Please include international code): Email Address:
Relationship with applicant:
Mother’s Name:
(as in MyKad or Passport)
Nationality of Mother:
Home Address (if this differs from the correspondence address above) :
City: Postcode: State: Country:
Telephone No. (Please include international code): Mobile No. (Please include international code): Email Address:
Relationship with applicant:
SECTION D ACADEMIC QUALIFICATIONS
Please specify all School/College/Professional qualifications that you have taken from Age 16 and their results. If the qualifications are in languages other than English, please also supply
certified translated copies. The documents must be certified by your current or previous education institution; a Manipal International University registered representative or agent; a
Manipal International University staff member; a solicitor; or commissioner for declaration. Manipal International University reserves the right to refuse documentation on the grounds of
incorrect certification or translation procedures.
Secondary Education
Part 1: SPM/O-Level/or equivalent
Year obtained: State/Country:
(where you studied)
Name of qualification type (Example: SPM/O-Level):
Name of school/institution:
List down the subjects attempted and score/grade achieved:
Subject Score/Grade Subject Score/Grade
Part 2: STPM/A-Level/Pre-U or equivalent (if applicable)
Year obtained: State/Country:
(where you studied)
Name of qualification type (Example: STPM/A-Level/SAM/CPU):
Name of school/institution:
Are you currently awaiting results of STPM/A-Level/Pre-U or equivalent?  Yes  No
Expected date of release of results (Month/Year):
List down the subjects attempted and score/grade achieved:
Subject Score/Grade Subject Score/Grade

3. © Manipal International University 2014 3
Part 3: Diploma/Undergraduates Studies (if applicable)
Name of Degree/Qualification:
Field of Study/Major/Specialisation: Name of Institution:
Date of commencement (Month/Year): Date of completion (Month/Year):
(If you have not completed the programme, please state last Month/Year attended)
State/Country:
(where you studied)
Did you complete the Diploma/
Undergraduates studies?  Yes  No
Are you currently awaiting results of any Diploma/Undergraduates studies?
 Yes  No
Expected date of release of results (Month/Year):
List down the subject attempted and score/grade achieved:
Subject Score/Grade Subject Score/Grade
SECTION E ENGLISH LANGUAGE PROFICIENCY
Please specify the details of any English Language qualifications you have obtained e.g. IELTS or TOEFL.
Test Name :
Marks/Grade/Points/Percentage :
Year Taken :
SECTION F CREDIT TRANSFER
Do you wish to apply for credit transfer from previous study?  Yes  No
If you request a credit transfer, please include relevant course/module syllabus(es) or curriculum from the university/college at which you pursued your programme. Please take note
that credit transfer would only be considered if the programme and institution are accredited by suitable accreditation authorities in your country.
SECTION G STUDENT VISA / PASS (For non-Malaysian passport holder)
All students with non-Malaysian passports are required to have a student visa/pass to study in Malaysia. Manipal International University will assist in processing the student
visa/pass. We require the following information to process your visa/pass.
Nationality : Place/Country of Birth :
Passport No. :
(If your country does not issue passports, please state the name of
the travel document you intend to use):
Place/Country where Passport was issued: Passport valid until (Day/Month/Year):
Is either of your parents a Malaysian citizen?  Yes  No
Is either of your parents a Malaysian Permanent Resident?  Yes  No
Have you ever applied to an educational institution in Malaysia?  Yes  No
If YES, please provide the name of the institution.
Have you ever held and obtained a student pass approval from any educational institution in Malaysia previously?
If YES, please provide the name of the institution
 Yes  No
Are you currently in Malaysia?
If YES, please state your visa/pass type (e.g. student, dependent, social)
 Yes  No
When will this visa and/or pass expire? Date (Day/Month/Year):

4. © Manipal International University 2014 4
SECTION H OTHER INFORMATION
The information collected in this section will NOT be used for making a decision on your admission.
Do you wish to stay in accommodation provided by Manipal International University?  Yes  No
How did you hear about Manipal International University?
 MIU Website/
Internet
 Newspaper/Magazine  Road Show/Open Day  Others (Please specify) Friends/Relatives:
______________________________________
SECTION I PRIVACY STATEMENT AND DECLARATION
Privacy Statement
Your personal information collected in this form or otherwise provided in support of your application (“Personal Data”) is processed, retained and used by Manipal International
University to assess your application for entry to a Manipal International University programme, to create an enrollment record on the student database, to prepare statistical analysis
and/or to inform you about your programme and other university programmes/events (collectively “Purpose”). If you do not complete all the questions on this form or do not consent
to the processing of your Personal Data for the Purpose, Manipal International University will not be able to process your enrollment as a student of Manipal International University.
Your Personal Data may be collected from or disclosed to relevant bodies for the verification of your grades, qualifications and/or experience, the processing of your visa application
and/or as otherwise required of Manipal International University by applicable laws or relevant authorities. Manipal International University may also retain and continue to process
your Personal Data after your completion of the programme enrolled for, or otherwise upon you ceasing to be a student of Manipal International University, for archiving purposes, in
relation to Manipal International University’s alumni events and activities and/or to maintain records of your grades, qualifications and/or experience as may be required by Manipal
International University and/or other institutions with whom you enroll for other programmes hereafter. All documents that you provide to Manipal International University become the
property of Manipal International University and will not be returned to you. You have the right to access or correct your Personal Data, or make inquiries or submit any concerns
thereto, by contacting the Admissions Office of Manipal International University at enquiry@miu.edu.my
Declaration
I hereby declare that I supply the information on this form and in support of this application on the understanding:
(a) that it may be used for purposes relating to my enrollment as a student, graduation, alumni and career enhancement by members of the academic and administrative staff of
Manipal International University;
(b) that it may be used for purposes external to the University when it is in statistical form where the disclosure is required and in compliance with the Data Protection Act 2010
or other Laws of Malaysia;
(c) that I have the right to see and correct if necessary the information I have provided;
I warrant that the information on this form, or provided in support of my application, is correct and complete. I acknowledge that the provision of incorrect information or the
withholding of relevant information relating to my application, including academic transcript(s), might invalidate my application and that Manipal International University may withdraw
an offer or a place or cancel my enrollment in consequence thereof. Should Manipal International University determine that I have submitted a false document, I consent to Manipal
International University disclosing this information to other relevant tertiary institutions.
I consent to any educational institution at which I have previously been a student and/or my current or any past employer, providing Manipal International University with information
which that institution or employer holds about me for the purpose of Manipal International University verifying my grades and/or qualifications and experience.
I further confirm and consent to the use by Manipal International University, without charge, my personal information including photographs, images or recordings of the student in
any publicity and/or promotional exercise of Manipal International University, including the publishing of examination results, the award of a prize or scholarship, any achievement,
academic or otherwise. I hereby authorise Manipal International University to release such relevant information to the relevant Alumni Association.
I agree to abide by the statutes, regulations and policies of Manipal International University at all times.
I have read and understood the above conditions, and agree and accept them fully.
Applicant’s signature Date (Day/Month/Year)

5. © Manipal International University 2014 5
SECTION J IMPORTANT CHECKLIST
Malaysian Applicants:
□ Application Form
□ 1 x Copy of MyKad
□ 1 x Certified true copy of academic transcript/result for SPM/O-Level/
or equivalent.
□ Certified true copy of academic transcript/result/qualification for
STPM/A-Level/ Pre-U or equivalent (if applicable).
□ Credit transfer application with certified true copy of relevant syllabus or
curriculum (if applicable).
□ 4 x passport-sized most recent colour photographs
(Blue background - 3.5cm x 5cm - Head Size: 2.5cm x 3cm)
□ 1 x Certified Medical Statement (For Section B only)
International Applicants:
□ Application Form
□ Application Fee of RM500 / USD170
□ 3 x full and clear copies of ALL pages of your passport(s) on A4-sized
paper (2 passport pages per A4 sheet, with NO enlargement)
including the blank pages**.
□ 5 x full and clear copies of ALL pages of your passport(s)** (for
students from China ONLY)
** It is highly recommended that the passport be valid for the minimum duration of the
programme. If the passport is expiring within one year from the time an application is to be
accepted, please apply for a new passport and submit photocopies of ALL pages of
BOTH passports.
□ 1 x Certified true copy of academic transcript/result for O-Level/ or
equivalent.
□ 1 x Certified true copy of academic transcript/result/qualification for A-
Level/ Pre-U or equivalent (if applicable).
□ Credit transfer application with certified true copy of relevant syllabus
or curriculum (if applicable).
□ 8 x passport-sized most recent colour photographs
(Blue background - 3.5cm x 5cm – Head / Size: 2.5cm x 3cm).
□ 1 x Certified Medical Statement (For Section B only)
□ 1 x Health Examination Report
□ 1 x No Objection Certificate (NOC) for applicant from sub-Saharan
countries.
□ 1 x Letter of Eligibility (LOE) for applicant from Nigeria (must be
issued by Federal Ministry of Education, Nigeria)
For International Applicants who have studied in Malaysia before:
□ The original release letter signed by the Chief Executive Officer from last institution of study in Malaysia .
□ Certified true copy of attendance reports from last institution of study in Malaysia.
□ Certified true copy of academic transcripts with information on the grading system* from last institution of study in Malaysia.
□ Certified true copy of Certificate of Completion from last institution of study in Malaysia
BANK DETAILS
Payable to : Manipal International University
Bank Name : Malayan Banking Berhad
Bank Account : 5551 0830 2982
Bank Address : PT 7443, Jalan BBN 1/2F, Bandar Baru Nilai, 71800 Nilai, Negeri Sembilan.
Branch Name : Bandar Baru Nilai
Branch Code : 5510
Swift Code : MBBEMYKL
APPLICATION SUBMISSION
The followings are the steps involved to submit your application.
 Fill in this APPLICATION FOR ADMISSION form
 Attach all required documents. The list of the required documents is available under the heading of IMPORTANT CHECKLIST above.
 The completed APPLICATION FOR ADMISSION form, together with the required documents, should reach the following address:
Admissions Office
Manipal International University (MIU)
No. 1, Persiaran MIU
71800 Nilai
Negeri Sembilan
MALAYSIA

6. © Manipal International University 2014 6
FOR OFFICE USE ONLY
BDM OFFICE/STAFF
□ Documents Complete
Counselled by,
_________________________________
Signature
Name:
Date:
□ Documents Incomplete
Specify :
CMS - Entered by,
Name: __________________________________ Date: __________________
AGENT
□ Documents Complete
Counselled by,
_________________________________
Signature
Name:
Date:
□ Documents Incomplete
Specify :
ADMISSION OFFICE
□ Documents Complete
Verified by,
_________________________________
Signature
Name:
Date:
□ Documents Incomplete
Specify :
Checked by:
Date:
CMS - Updated by,
Name: __________________________________ Date: __________________
ADMISSION COMMITTEE
□ Firm Offer □ KIV
Verified by,
_________________________________
Signature
Name:
Date:
□ Rejected
Feedback to Applicant: